Download In-Hospital Stroke Practice Event

In-Hospital Stroke Practice Event
“Mock Stroke”
Staff needed:
Nurse
Stroke response team
CT technician
Available equipment needed:
Empty patient room on general ward
Bed capable of transporting patient to CT
Glucometer
IV equipment
Blood draw equipment
Room oxygen and portable oxygen
Cardiac monitor for transportation
Stroke Response Team should be aware that practice in-hospital stroke alerts will
occur in advance of the actual event, but the specific time and date of the practice
stroke alert should not be known.
Participating nurse should be from a general ward unit and not necessarily have
specific neurology training. Nurse should be briefed just before stroke alert to treat
the practice stroke alert exactly as they would if it were a real patient.
A mannequin or volunteer can be used to represent the patient. IVs, blood draws
and CT scan should be mimicked but not actually performed. Time taken for tasks
should approximate what would occur in real situation. Stroke program leadership
should be present to provide information about outcome of activities such as results
of vitals, finger stick glucose and neurological assessment.
Clinical Scenario
The patient is a 78 year old male with a history of hypertension, coronary artery
disease, diabetes mellitus type II and hyperlipidemia. He was admitted three days
prior for non-ST elevation myocardial infarction and pyelonephritis. He was taken to
diagnostic angiography and had a drug eluting stent placed in his right coronary
artery by cardiology primary team.
Medications include aspirin, clopidogrel, metoprolol, Lisinopril, atorvastatin, insulin
glargine, insulin lispro correction factor sliding scale, ceftriaxone, and heparin
prophylaxis.
Patient is initially on room air and has a 22 gauge IV in the left hand.
The patient was last seen normal one hour prior without neurologic deficits.
On assessment, the nurse notes right-sided hemiparesis and aphasia. Nurse
activates stroke alert.
Start clock at time of stroke alert.
Encourage staff to state out loud the activity they are performing.
Document activities using in-hospital stroke alert record.
Staff activity
Result (may be provided by Stroke Program Staff)
RN reports to response team estimated
time of onset.
RN records vital signs.
Quality of communication assessment
Provide oxygen by NC or mask. Portable
oxygen will be needed for transportation.
Place new IV. Minimum 20 gauge in
anticubital.
Notify primary team. (Don’t page
cardiology.)
Draw finger stick blood glucose.
Draw appropriate panel of blood for testing.
Set up portable oxygen for patient.
O2 saturation increases to 95%
Set up portable monitor for patient.
Stroke response team performs NIHSS.
Order labs.
Brain Imaging
Inform radiology technician of stroke
patient.
Transfer patient to brain imaging.
BP 170/90, HR 115, RR 20, O2 Sat 88% on RA, Temp 37.0
For patient to receive CT angiogram, new IV would be needed.
Inform that primary team will be on site in 30 minutes.
BG 200
Results of tests will not return until after CT scan.
If patient transported without oxygen, announce that the patient
is desaturating to 82% in elevator or hallway halfway to CT.
If patient transported without monitor, announce that patient has
syncope and a thready pulse of 180.
1. LOC—alert (0 points)
1b. Answers both questions correctly with slurred speech
(0)
1c. Follows both commands (0)
2. Gaze—normal (0)
3. Visual—normal (0)
4. Facial palsy—partial on right (2)
5. Motor arm—some effort against gravity on right (2)
6. Motor leg—no effort against gravity on right (3)
7. Limb ataxia—none (0)
8. Sensory—mild to moderate sensory loss on right side
(1)
9. Language—Mild to Moderate aphasia (1)
10. Dysarthria—mild to moderate (1)
11. Extinction and inattention—none (0)
Total Score—10
Labs should include minimum: STAT CBC, Chem 7, PT/PTT/INR
Results of tests will not return until after CT scan.
Stat brain imaging. Usually starts with non-contrast head CT.
If technician not informed in advance, then CT will be delayed for
patient already in scanner.
Team should accompany patient to brain imaging location.
Stop clock at time patient is loaded onto CT scan and the scan is able to proceed.
Mock In-Patient Code
Stroke Drill
Feedback Tracking Form
EVENT
Found with symptoms
ABC’s and VS
FS glucose obtained
Code stroke called
Stroke response team to
bedside
Quality of nurse to
stroke response team
communication
Last time known well
obtained
CT technician notified of
impending stroke alert
Transfer to CT
Monitor
Nurse
Labs drawn
Intervention/Treatment
Decision
TIME
FEEDBACK